- Highmark Health (Boston, MA)
- …they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance ... parties. + Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross functional… more
- Evolent (Boston, MA)
- …supporting Evolent's clinical services (ie, specialty care, utilization management, care management, appeals & grievances ) + Using analytical tools to integrate ... Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Analyst , Client Analytics** Integrate and analyze claims and enrollment data from multiple… more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements… more